Global Health Policy: A Case Study of Multi-drug-resistant Tuberculosis
Multidrug-resistant tuberculosis (MDR-TB) represents a serious obstacle to global TB control efforts. Treatment of MDR-TB via "DOTS" -- the international strategy for TB control that relies on first-line anti-TB drugs -- has proved inadequate. Generally, MDR-TB patients in relatively wealthy, developed countries receive specific treatment with second-line anti-TB drugs. In contrast, in developing countries such treatment has not been widely recommended or implemented for reasons including the regimen's high cost; the long duration of treatment; the possibility of serious adverse events; the potential for further development of drug resistance; the focus on prevention rather than treatment of the disease; and the intensive laboratory monitoring purportedly required for successful treatment.
In 1999, the World Health Organization and its international partners launched DOTS-Plus for MDR-TB, a programmatic strategy for treating MDR-TB patients in developing countries. Through a rigorous policy development process that includes a novel mechanism for increasing access to and rational use of second-line drugs, several DOTS-Plus pilot projects were established globally. Preliminary results from the DOTS-Plus initiative indicate that the approach is feasible, effective and cost-effective in resource-poor areas. Key lessons can be extracted from this effort, specifically in reference to scaling up anti-retroviral treatment for HIV/AIDS.